1. Click your mouse or press the space bar to continue.
EXERCISE
Modes of
Ventilation
In this exercise, you are working in the ICU. A situation will arise in which you must make a decision. Pay close attention to how your decision will affect the
patient’s progress.
Click your mouse or press the space bar to continue.

2. Click a choice below to see how your decision will affect the patient.
SITUATION
Mr. Jones has been admitted to the ICU for the diagnosis of an acute exacerbation of COPD. He quickly deteriorates before your eyes, and now requires mechanical ventilation. His respiratory rate is 40 breaths per minute, heart rate is 180 beats per minute, blood pressure is elevated, he is diaphoretic, and using accessory muscles to breathe in a tripod position. What is the best choice for Mr. Jones, based on his lung condition, to optimize recovery and “rest” him?
What will you do?
Mr. Jones has been admitted to the ICU for the diagnosis of an acute exacerbation of COPD. He quickly deteriorates before your eyes, and now requires mechanical ventilation. His respiratory rate is 40 breaths per minute, heart rate is 180 beats per minute, blood pressure is elevated, he is diaphoretic, and using accessory muscles to breathe in a tripod position. What is the best choice for Mr. Jones, based on his lung condition, to optimize recovery and “rest” him?
Click a choice below to see how your decision will affect the patient.

3. Click a choice below to see how your decision will affect the patient.
SITUATION
With this choice Mr. Jones will have little to no work of breathing, he will be able to rest. Every breath will be
the same size.
What will you do?
Choice A Results
Click a choice below to see how your decision will affect the patient.

4. EXCELLENT!
This mode allows for some guarantees without the patient having to contribute. Because Mr. Jones has COPD, a concern in this mode would be potential for pneumothorax because of the guaranteed volume delivery and potential
for air trapping.
Choice A (Best) Results -> Choice 1

5. Not the
best choice
This mode allows for care of the potential barotrauma, but we must sacrifice volume guarantees. Based on lung compliance and airway resistance, this will dictate volume delivery, and it may be inadequate.
Choice A (Best) Results -> Choice 2

6. FAILED
Choice C Results
In this choice, Mr. Jones has suffered respiratory and cardiac arrest and has died.

7. Click a choice below to see how your decision will affect the patient.
SITUATION
In this choice, Mr. Jones may contribute to his breathing. So he will have some work of breathing. You can control some of this by choosing an appropriate RR to limit his work of breathing.
What will you do?
Choice B Results
Click a choice below to see how your decision will affect the patient.

8. Not the
best choice
Mr. Jones is tired, do you want him to work? If the rate is not high enough to meet his demand, that’s what will happen. Pressure support may help with some of this. The same volume concerns as with control ventilation
apply here too.

9. Not the
best choice
How much work do you want for Mr. Jones? Pressure support can help here too. Volumes are still going to be variable, barotrauma can be curbed. Make sure the rate is high enough to overcome Mr. Jones’ work of breathing.